Latin American Governments Attempting To Boost EC Access In Light Of Lessening Catholic Influence On Sexuality, Reuters Reports

Governments across Latin America are attempting to increase access to emergency contraception -- which can prevent pregnancy if taken within 72 hours of sexual intercourse -- despite "stiff resistance" from the Roman Catholic Church, Reuters reports. Chilean President Michelle Bachelet last year announced a policy to distribute EC at public hospitals at no cost to girls as young as age 14; Mexico has required EC to be distributed at all public hospitals; and Peru has offered it at no cost. Public hospitals in Buenos Aires, Argentina, also offer EC at no cost, and a bill pending in country's Congress would expand the service nationwide. Argentine Catholic bishops have urged Congress to reject the bill, saying that EC "an assault on human life" and that the legislation would violate the country's constitution. According to Reuters, EC has gained more "acceptance" throughout Latin America "as people increasingly ignore traditional church teachings on sexuality." Margarita Berkenwald, coordinator of the sexual and reproductive health program in Buenos Aires, said, "This is part of a historic process in our region, a process of evolution in which reproductive rights are increasingly seen as people's rights." EC is available without a prescription in about 40 countries worldwide (Burke, Reuters, 1/7).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Unmarried U.S. Women Delivered Record 1.47M Infants in 2004, Report Says

Unmarried U.S. women gave birth to a record 1.47 million infants in 2004, accounting for 35.7% of all births in the country for the year, according to a preliminary report released on Friday by the National Center for Health Statistics, the AP/Seattle Post-Intelligencer reports (Schmid, AP/Seattle Post-Intelligencer, 10/28). In 2003, single women in the U.S. delivered 1.4 million infants, according to NCHS' final report on 2003 birth data, which was released last month (Kaiser Daily Women's Health Policy Report, 9/12). The increase in the number of births to single women occurred primarily among women in their 20s, specifically between the ages of 25 and 29. Most of the women in that age group are living with partners but are not officially married, NCHS researcher Stephanie Ventura said. She added that the 20s are principal childbearing years, whether women are married or single. The birth rate among women ages 30 and older continued to increase in 2004, according to Brady Hamilton of NCHS, a trend he said shows the decisions women are making about family and career. Teenagers accounted for about 24% of births to single women in 2004, according to Ventura. The birth rate for women ages 15 to 19 was 41.2 per 1,000 women in 2004, a record low. The teen birth rate was 61.8 per 1,000 in 1991 and has been declining since (AP/Seattle Post-Intelligencer, 10/28).


"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

RCOG Release: RCOG Pilots Its ATSM At The Corniche Hospital, UK

The Royal College of Obstetricians and Gynaecologists (RCOG) has selected Corniche Hospital in Abu Dhabi, the UAE as the first site outside the UK to be accredited to provide training in the RCOG's Advanced Training Skills Module (ATSM) in Maternal Medicine.


As part of its commitment to improving clinical and educational standards in the UK and internationally, this programme supports postgraduate medical training overseas. It will be run to the same high standards as in the UK and enables doctors from the region to travel closer to home, instead of to the UK, for training.


Dr Maggie Blott, former Vice President (Education) of the RCOG said "The RCOG is committed to improving the care for women and their babies. The provision of RCOG recognised training in units outside of the UK, delivered to the same standards as in the UK, will undoubtedly enhance clinical care and improve outcomes.


"The RCOG is delighted that the Corniche hospital has been approved to provide this training, which will improve care for women in the UAE. The next step is to extend the provision of this training to other units worldwide."


Dr Mariyam Noushad has been selected to be the first trainee under this program. Dr Noushad said, "As the first trainee for the ATSM in maternal medicine outside the UK, I am honoured by this special opportunity. It is an important step in my career path. I believe that the skills acquired during this program will help me to enhance my medical and clinical expertise."



Notes


UK doctors undergoing postgraduate medical training in O&G in the UK must complete a minimum of two ATSMs in order to obtain the Certificate of Completion of Training (CCT) in obstetrics and gynaecology. For more information about the training curriculum and ATSMs, click here.

The Corniche Hospital


The 235-bed Corniche Hospital, the largest maternity health care facility in the UAE, is managed by Johns Hopkins Medicine International and is part of the SEHA HealthSystem owned and operated by Abu Dhabi Health Services Company PJSC (SEHA).

GOP Chair Steele's Comments On Abortion Spark Criticism From Abortion-Rights Opponents

Republican National Committee Chair Michael Steele issued a statement on Thursday in an effort to clarify his recent comment that abortion is an "individual choice," the New York Times reports. According to the Times, Steele made the comment during an interview with GQ magazine that was published online Thursday. In addition, Steele said that abortion-related policy decisions should be made by the states. He said, "That's what the choice is. The individual choice rests in the states. Let them decide."

The interview "rippled through Republican circles as soon as it was posted," prompting Steele to issue a statement attempting to clarify that he is an opponent of abortion rights, the Times reports (Nagourney, New York Times, 3/12). In the statement, Steele -- who was adopted as an infant -- said he "tried to present why I am pro-life while recognizing that my mother had a 'choice' before deciding to put me up for adoption." He added that he "thank[s] her every day for supporting life" (Cillizza/Bacon, Washington Post, 3/13). The Republican Party "is and will continue to be the party of life," Steele said in the statement, adding that it is "important that we stand up for the defenseless and that we continue to work to change the hearts and minds of our fellow countrymen so that we can welcome all children and protect them under the law."

However, Steele's "clarification did little to satisfy some angry conservatives," the Boston Globe reports (Williams, Boston Globe, 3/13). Tony Perkins, president of the Family Research Council, criticized Steele's comments as "flippant" and "cavalier." He said the remarks "reinforce the belief by many social conservatives that one major party is unfriendly while the other gives only lip service to core moral issues" (Washington Post, 3/13). Former Arkansas Gov. Mike Huckabee (R) said, "For Chairman Steele to even infer that taking a life is totally left up to the individual is ... a reversal of Republican policy and principle," adding that the GOP "stands to lose many of its members and a great deal of its support in the trenches of grassroots politics" (Davis, Wall Street Journal, 3/12).

After meeting with Steele later in the day, Huckabee said, "I am grateful that Chairman Steele was willing to set the record straight without hesitation." Other abortion-rights opponents also said that they are satisfied with Steele's statement. James Bopp, a lawyer and abortion-rights opponent, said that he has "never had any doubt that Steele is personally pro-life," adding that Steele's "clarification was needed and should put this to rest" (Washington Post, 3/13). According to the Times, it "appears highly unlikely that there would be any serious move to recall" Steele (New York Times, 3/12).

NPR's "All Things Considered" on Thursday examined the effect that Steele's comments could have on his career as chair of the RNC, as well as the impact they could have on the Republican Party as a whole (Halloran, "All Things Considered," NPR, 3/12).


Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.


© 2009 The Advisory Board Company. All rights reserved.

"Female Athlete Triad" ACSM Position Stand Now Available

The American College of Sports Medicine (ACSM) released its Position Stand on "The Female Athlete Triad," recognizing the relationships among energy availability, menstrual function and bone mineral density, which may manifest into eating disorders, amenorrhea (absence of menstrual period), and osteoporosis in at-risk female athletes.


Triad disorders are thought to be most common among female athletes in sports or activities which emphasize a lean physique or low body weight, such as gymnastics, swimming, or track and field.


The updated Position Stand makes new recommendations for screening, diagnosis, prevention, and treatment for the Triad. Among its recommendations, the Position Stand emphasizes:


- Low energy availability is an important factor that impairs reproductive and skeletal health in the Triad.


- For prevention and early intervention, education of athletes, parents and coaches, trainers, judges and administrators is a priority.


- Athletes should be assessed for the Triad at the pre-participation physical and/or annual health screening exam, and whenever an athlete presents with any of the Triad's clinical conditions.


- The treatment team should include a physician or other healthcare provider, a registered dietitian, and for athletes with eating disorders, a mental health counselor.


- The first aim of treatment for any Triad disorder is to increase energy availability by increasing energy intake and/or reducing energy expenditure.


- Athletes with eating disorders should be required to meet established criteria to continue exercising, and their training and competition may need to be modified.


- No pharmacologic agent adequately restores bone loss or corrects the metabolic abnormalities that impair health and performance in athletes with amenorrhea.


"We are making a clear statement that the benefits of exercise far outweigh the risks," said Aurelia Nattiv, M.D., FACSM, Chair of the writing committee. "But it is important the Triad is recognized and treated so it does not lead to long-term and possibly irreversible health outcomes, such as osteoporosis."


The Position Stand includes in-depth explanations of the three interrelated spectrums (energy availability, menstrual function, and bone mineral density), as well as sections on health consequences, prevalence, and risk factors. Prevention recommendations emphasize education, and ask national and international governing bodies of sports to put policies in place that eliminate potentially harmful weight loss practices or expectations.


"The Female Athlete Triad" replaces and updates the 1997 Position Stand of the same title.


The American College of Sports Medicine is the largest sports medicine and exercise science organization in the world. More than 20,000 international, national, and regional members are dedicated to advancing and integrating scientific research to provide educational and practical applications of exercise science and sports medicine.


Medicine & Science in Sports & Exercise® is the official journal of the American College of Sports Medicine, and is available from Lippincott Williams & Wilkins.

acsm

The Contraceptive Pill And HRT May Protect Against Cerebral Aneurysm

Women who develop cerebral aneurysms are less likely to have taken the
oral
contraceptive pill or hormone replacement therapy, suggesting taking
oestrogen could have a protective effect, reveals research published in
the
Journal of NeuroInterventional Surgery.


Cerebral aneurysms, weaknesses in the blood vessel walls of the brain
which
cause the vessels to balloon, occur more frequently in women, and it has
been suggested that female hormones may play a role in their development.
If the cerebral aneurysm ruptures, because the ballooning wall bursts,
this
can be life threatening and is known as a haemorrhagic stroke.


Oestrogen helps maintain the structure of blood vessel walls by promoting
the division of endothelial cells within the vessel walls, which is
important for repair if the vessels become damaged. However, oestrogen
levels drop significantly at the menopause.


Women have been shown to be more likely to develop a cerebral aneurysms
after the age of 40 years, and aneurysms are most likely to rupture
between
the ages of 50 and 59 years.


The authors asked 60 women with cerebral aneurysms about their use of the
oral contraceptive pill and hormone replacement therapy, and this was
compared with usage in 4,682 other women drawn from the general public.


Women with cerebral aneurysms were found to have been significantly less
likely to have taken oral contraceptives or hormone replacement therapy.
Women with cerebral aneurysms also had an earlier average age of
menopause.


Previous studies have shown that use of the oral contraceptive pill
protects against haemorrhagic stroke in later life, while women who start
their periods early and/or do not have children are at greater risk.


Current medical management of unruptured cerebral aneurysms is limited and
consists mainly of smoking cessation and blood pressure control. The
alternative is a surgical intervention, such as the insertion of a coil or
placement of a clip, to try to control the aneurysm, and a lifetime of
anxiety.


The authors say that the results of this study may not only provide
additional insight into how cerebral aneurysms develop and progress, but
more importantly may lead to new therapies for patients, either harbouring
an unruptured cerebral aneurysm or at risk of developing one, that address
their underlying vascular predisposition towards aneurysms.


Source
Journal Of Neurointerventional Surgery

Dysuria At Onset Of Interstitial Cystitis/Painful Bladder Syndrome In Women

UroToday- Painful urination or "dysuria" has not been considered a prominent part of the PBS/IC syndrome complex, and is more often associated with urinary tract infection or recent urethral instrumentation.


Warren and colleagues at the University of Maryland are conducting an ongoing case-control study to identify risk factors for the disease. As a part of this study, subjects with recent onset disease were asked to recall antecedent events. They report that a small majority of patients indicate that pain or burning on urination began at the onset of PBS/IC.


54% of 138 recent-onset PBS/IC patients indicated that at their onset date they had started to experience symptoms of dysuria. Of note, the characteristic symptoms of pelvic pain and urgency were similar in groups with and without dysuria as a presenting complaint. Frequency was a presenting symptom in 93% of dysuria patients compared with 81% of those with no dysuria on presentation.


A further study may explain the dysuria in many of the patients. While only a minority of patients had urine sample cultured, 34% of those with dysuria had a positive culture as compared with 5% of those without dysuria. All but one pathogen grew out at greater than 10,000 colonies per milliliter. 43% of dysuria patients had pyuria compared with only 8% of those without dysuria. The authors conclude based on this and other data that at the onset of PBS/IC, significantly more of those with dysuria had evidence of urinary tract infection that those without pain during urination.


Warren comments on 3 other epidemiologic studies that addressed the question of dysuria as a presenting complaint, and concludes that all studies, using different methodology in different patient populations, reported 46% - 60% of patients at the onset of disease had dysuria or patient reported "UTI".


I suppose the message here is not to discount the possibility of PBS/IC in the patient presenting with dysuria in the absence of a positive urine culture.


J. Warren, C. Diggs, V. Brown, W. Meyer, S. Markowitz, P. Greenberg

Urology,? Volume 68,? Issue 3,? Pages 477-481


Reviewed by UroToday Contributing Editor Philip M Hanno, MD, MPH


UroToday - the only urology website with original content global urology key opinion leaders actively engaged in clinical practice.


To access the latest urology news releases from UroToday, go to:

www.urotoday


Copyright © 2006 - UroToday

36% Drop In Hospitalization Rates For Cervical Cancer Cases, 1994 - 2004, USA

Hospitalization rates for cervical cancer cases declined 36 percent between 1994 and 2004 - from 25.9 to 16.6 admissions per every 100,000 women, according to the latest News and Numbers issued by the Agency for Healthcare Research and Quality. The number of admissions per year fell from 34,600 to 24,800 during the period.


The study found that in 2004:


-- Cervical cancer hospitalizations were over 40 percent higher in the South than in the West (19.0 versus 13.2 admissions per 100,000).


-- Women ages 18 to 44 accounted for half of all hospitalizations for cervical cancer and women ages 45 to 64 accounted for 37 percent.


-- Hysterectomy was performed in 60 percent of all hospital stays for cervical cancer. Women in the West were nearly 40 percent more likely to have a hysterectomy than women in the Northeast


-- Private insurers were billed for half of the hospital stays for cervical cancer, Medicaid was billed for 28 percent, Medicare got the bill for 11 percent of the stays, and 7 percent of were uninsured.


This News and Numbers is based on data in Hospital Stays for Cervical Cancer, 2004, HCUP Statistical Brief # 22. The report uses statistics from the Nationwide Inpatient Sample, a database of hospital inpatient stays that is nationally representative of all short-term, non-federal hospitals. The data are drawn from hospitals that comprise 90 percent of all discharges in the United States and include all patients, regardless of insurance type as well as the uninsured.


ahrq

University Of Leicester Medical Team Announces 'Predictor' For Pregnant Women Who May Have Miscarriages

A medical team from the University of Leicester has been able to establish for the first time a predictor for pregnant women who may have miscarriages and those who won't. Their research is published in the highly prestigious Journal of the American Medical Association.


The researchers measured the levels of a naturally occurring 'cannabis' (an endocannabinoid) known as anandamide in women who presented with a threatened miscarriage (bleeding in early pregnancy with a viable baby) and found that those who at the time of the test had significantly higher levels of anandamide subsequently miscarried.


Professor Justin Konje, who heads the Endocannabinoid Research Group of the Reproductive Sciences Section in the Department of Cancer Studies and Molecular Medicine at the University of Leicester, said: "We are extremely excited by these findings. Essentially, we have for the first time been able to use the levels of this naturally occurring cannabis, anandamide in 45 women presenting with threatened miscarriage and a viable pregnancy to predict the eventual outcome of the pregnancy. Using a threshold we defined from this study, we were able to predict all the women who then went on to have a subsequent miscarriage and 94% of those who went on to have a live birth.


"This is the first time that this has been reported. It has very significant implications and if the results are replicated, we would eventually be able to reassure women who present with bleeding in early pregnancy about the outcome of their pregnancies.


"Obviously for those whose pregnancies are identified by this measurement as destined to end in a miscarriage, knowing this may cause grief and upset but it may also help them to come to terms quickly with the outcome of the pregnancies.


"This is the first stage of this study but the results are very encouraging and we are undertaking further studies to confirm our observations. Once these are confirmed, we plan to develop a bed-side test which could then be applied in clinical practice."


In the paper, the authors state that approximately 40%-50% of all human conceptions are lost before 20 weeks of gestation. They conclude:


"In this pilot study of women with threatened miscarriage, high plasma anandamide level was associated with subsequent miscarriage. The study is limited by the small number of participants and requires replication in larger and more diverse populations. Compared with tests based on peripheral blood mononuclear cells, anandamide-level measurement has an advantage of being based on whole blood and not requiring separation. If established as valid and clinically practical, anandamide measurement has the potential for improving the prediction and counselling of women presenting with threatened miscarriages."


Professor Konje based at the Leicester Royal Infirmary, carried out the study with Osama Habayeb, Anthony H. Taylor, Mark Finney and Mark D. Evans. Professors David Taylor and Stephen Bell and Dr Marcus Cooke of the University of Leicester also contributed to the study.The study was funded by income from the University Hospitals of Leicester NHS Trust and by PerkinElmer through a grant to support the Endocannabinoid Research Laboratory of Dr Konje. The British United Provident Association (BUPA) Foundation funded some of the consumables used for the laboratory analysis.















Additional Information:


Professor Konje has been researching the levels of compounds produced by the human body, which are very similar to cannabis, for a number of years. Previously, his team reported than the levels of these endocannabinoids fall during the early period of pregnancy and rise towards term. Measuring the endocannabinoid level in women who were delivering preterm, Professor Konje and his team discovered that the level of endocannabinoids was four times higher in those who went on to deliver compared to those who did not.


Since a large number of women go into hospital with preterm labour, but only a few actually go on to have premature babies, this may be one of the most reliable ways of distinguishing those who are going into early labour from those whose contractions will subside until later in the pregnancy.


The implications for this are highly significant, both in health management and in cost-effectiveness. Professor Konje commented: "When women present with preterm labour, we need a test to tell us which ones will deliver and which ones will not so that we can plan their management.
"But there is also a major cost factor in the management of these women and babies. In the UK 8% of babies are delivered prematurely but many more women present with signs of preterm labour. A day on the intensive care unit costs ??1,000-??1,500, so knowing who actually needs this level of care would be a major step forward."


Currently, it can take 12 hours to get results from a blood test. His research aims to develop a means of monitoring monoclonal antibodies which could deliver the same result in 10-15 minutes.


University Of Leicester

Drop In Calif. Teen Births Shows Effectiveness Of State's 'Enlightened Approach' To Pregnancy Prevention, Editorial Says

California governors of the past two decades "deserve praise for funding a wide array of programs aimed at combating teen births," a Sacramento Bee editorial states. The editorial notes that California is "bucking a national trend" of rising teen births. The number of births to California teens ages 15 through 19 dropped to 35.2 per 1,000 teens in 2008, down from 37.1 births per 1,000 teens in 2007. The teen birth rate in California has been declining steadily since 1991, when there were 70.9 births per 1,000 teens, the editorial says. "Back then, California's rate also was significantly higher than the nation as a whole," it adds. Now, "[w]hile California's teen birth rate declines, the national rate rises," the editorial states. In 2007, the U.S. rate was 42.5 births per 1,000 teens, according to the editorial.

"California has taken an enlightened approach with programs including abstinence, counseling, contraceptives and state-funded abortions for unwanted pregnancies," the editorial continues. It notes that California is the only state to consistently reject federal money for abstinence-only sex education since 1997. Now, faced with a state budget crisis, Gov. Arnold Schwarzenegger (R) has called for cuts to Family PACT, a family planning program that "is credited with averting an estimated 300,000 pregnancies a year," according to the editorial.

The Schwarzenegger administration "would impose this cut only if the Obama administration fails to provide sufficient health care funds," the editorial says. It concludes, "Obama opposes the abstinence-only concept. The feds now need to take the next step by helping California's overall effort" (Sacramento Bee, 3/3).


Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.


© 2010 The Advisory Board Company. All rights reserved.

Girls Decide: Putting Girls' Sexual And Reproductive Health At The Heart Of Development, UK

There is a growing global consensus that girls are central to global development. Yet issues relating to girls' sexuality and their sexual and reproductive rights continue to be largely neglected. Girls Decide, a new initiative from the International Planned Parenthood Federation (IPPF), highlights the importance of girls' and young women's sexual and reproductive lives for both individual and global development, and aims to ensure governments around the world to adopt policies that work for girls.



Complications related to pregnancy and childbirth, including unsafe abortion, are the most common causes of death among adolescent girls. The Girls Decide initiative aims to reduce the risks related to girls' pregnancy and to improve the health, well-being and development of girls and young women worldwide. Ensuring girls' and young women have access to life-saving and life-enhancing SRH services and information is a human rights imperative and essential to tackle gender inequality and ill-health.



Girls Decide launches this week with six short films that share the stories of six girls from around the world and their journeys to make informed decisions about sex, pregnancy, abortion and relationships. The initiative will be launched at an event in London on 16 February attended by UK Parliamentary Under-Secretary of State for International Development, Stephen O'Brien, MP.



Stephen O'Brien, Minister for International Development, said: "One thousand women die everyday in pregnancy or childbirth. They die not from incurable disease or chronic illness but from conditions and complications that we have the power to prevent.



"That is why the Coalition Government has put women and girls at the heart of our development plans. Our plans will double the number of lives saved in pregnancy and childbirth in the world's poorest countries by 2015.



"We will train more midwives to ensure women give birth safely, provide access to quality healthcare and make contraception more readily available to help unintended pregnancies.



"Empowering adolescent girls so they can make healthy choices is at the centre of Britain's development work and we join with the IPPF in urging others to do the same - today."



Gill Greer, Director General of IPPF, said: "The world needs to do more for girls and young women. Girls and young women are powerful agents of change and pivotal for the development of communities and nations. However, around the world, girls are most affected by inequity and poverty. This is clearly seen in the neglected areas of girls' sexuality and their sexual and reproductive rights. Withholding girls' and young women's right to decide and the means to act upon those decisions perpetuates inequality and ill-health"



"Young people account for forty per cent of IPPF's 70 million health services each year, and the bottom line of IPPF's work with young women and girls is that we are committed to their sexual rights and we are there to support them with their decisions, whatever their choice may be."
















Yet, with less than 2 cents of every dollar spent on international development directed specifically toward adolescent girls, greater mobilisation and sustained leadership is required to ensure that girls are recognized rights-holders and have expanded access to choices, opportunities, education, services and support. Such efforts will not only have positive impacts on girls and young women, but are also essential to achieve the Millennium Development Goals and other development priorities.



Girls Decide films and more information can be found here.

Notes



Imagine a 16-year-old girl walking home...



Now imagine that she is pregnant and imagine all of the thoughts that must be going through her head. . . What if she doesn't want to continue her pregnancy? What if she wants to keep her pregnancy? What if she is forced to keep her pregnancy or stop her pregnancy? What if she is unmarried? What if she wants to continue her studies? What if she is forced into marriage? What if she has been raped? What if she is living with HIV? What if she never wanted to get pregnant? What if...




The Facts



- About 16 million girls aged 15 - 19 give birth each year, accounting for about 11% of births worldwide;


- Complications related to pregnancy and childbirth, including unsafe abortion, are the most common causes of death among adolescent girls;


- About 2.5 million adolescents have unsafe abortions every year and account for 46% of deaths related to unsafe abortion worldwide;


- Adolescents girls aged 10 - 19 account for 23% of the overall burden of disease due to pregnancy and childbirth worldwide;


- In developing countries, more than 60 million women aged 20-24 were married or in a union before the age of 18;


- 2 million girls and young women are currently enslaved in the global sex trade;


- It is estimated that 150 million young women under the age of 18 have been raped or subjected to sexual violence.


Source:

International Planned Parenthood Federation

Heavy Mums More Likely To Have Larger Infants

A study in the Australian and New Zealand Journal of Obstetrics and Gynecology published by Wiley-Blackwell finds that overweight mothers have a higher chance of delivering a second large baby after having a first macrosomic baby.


Lead author of "Maternal weight characteristics influence recurrence of fetal macrosomic in women with normal glucose tolerance", Rhona Mahony examines the relationship between maternal weight and recurrence of fetal macrosomia in non-diabetic women delivering a second infant following first macrosomic pregnancy and finds that increased body mass index (BMI) elevated the risk of a recurrent macrosomic pregnancy.


Out of the 111 women who delivered a first macrosomic baby, about one-third gave birth to a second macrosomic infant. These women who had a second large baby were heavier at the start of the pregnancy compared to women without recurring macrosomic babies.


Another factor that increases the risk of recurrent macrosomic pregnancy is excessive maternal weight gain during pregnancy.


"Women with macrosomic firstborns should not gain excessive weight during second pregnancy to decrease the risk of having another large baby", says Dr. Mahony.


She added, "An increase of more than 11 kg in the second pregnancy increased the risk of a macrosomic baby by three times, and the risk of having a recurrence of macrosomia by fivefold."



This paper is published in the October 2007 issue of The Australian and New Zealand Journal of Obstetrics and Gynecology. Media wishing to receive a PDF or schedule media interviews with the authors should contact Alina Boey, PR & Communications Manager Asia at alina.boeyasia.blackwellpublishing.


Australian and New Zealand Journal of Obstetrics and Gynaecology


The Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG) is an editorially independent publication owned by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the RANZCOG Research foundation. ANZJOG aims to provide a medium for the publication of original contributions to clinical practice and/or research in all fields of obstetrics and gynaecology and related disciplines. Articles are peer reviewed by clinicians or researchers expert in the field of the submitted work.


About Wiley-Blackwell


Wiley-Blackwell was formed in February 2007 as a result of the merger between Blackwell Publishing Ltd. and John Wiley & Sons, Inc.'s Scientific, Technical, and Medical business. Together, the companies have created a global publishing business with deep strength in every major academic and professional field. Wiley-Blackwell publishes approximately 1,250 scholarly peer-reviewed journals and an extensive collection of books with global appeal.


This release is also posted online here.


blackwellpublishing

Common Vaginal Infection May Increase Risk Of HIV Infection

A common vaginal infection may make women more susceptible to contracting HIV, the virus that causes AIDS, University of North Carolina at Chapel Hill School of Public Health researchers have found.


An analysis of 23 published studies, including data from more than 30,700 women from around the world, showed that women with bacterial vaginosis the most common type of vaginosis in women of reproductive age were more likely than others to be infected with HIV. The association between bacterial vaginosis (BV) and HIV was stronger for women without high-risk sexual behavior.


The results of this meta-analysis have been published in the peer-reviewed journal, AIDS.


"Given that bacterial vaginosis and HIV infection are both transmitted sexually, it is difficult to determine whether associations found are causal, or if there is some other reason why women with BV are more likely that others to become infected with HIV," said Jennifer S. Smith, epidemiology research assistant professor in the UNC School of Public Health. "If additional follow-up studies show that there was a relationship between BV and the risk of incident HIV infection, though, then increasing the treatment of BV could be considered for the future prevention of HIV infection."


Bacterial vaginosis is an imbalance in the type of bacteria normally found in the vagina. BV has been shown to cause gynecological and obstetrical problems including preterm delivery, pelvic inflammatory disease and upper genital tract infections.


Other research has shown that BV results in several changes in the vagina that could explain why it increases the risk of HIV, such as a depletion in a type of bacteria that are believed to play a role in defending the vagina against microorganisms including HIV, and higher pH levels that may increase the adherence and survival of the virus.


The studies analyzed by Smith and colleagues included women from the U.S., Malawi, Kenya, South Africa, Thailand, Uganda, Zimbabwe, Tanzania, South Africa, Nigeria, Burkina Faso and Gambia. Prevalence of BV in women in these countries ranged from about 11 percent to as high as 70 percent.


The analysis of data indicates that BV increases the risk of acquiring HIV by about 60 percent. The association between BV and HIV infection was weaker in high HIV-risk groups, Smith said. "That may be because women in high-risk groups have a greater risk of acquiring HIV from causes other than BV. This could be helpful information in identifying which populations would be helped most through targeted bacterial vaginosis control measures."


In addition to Smith, researchers from the UNC department of epidemiology who contributed to the study included doctoral student Julius Atashili; associate professor Charles Poole; and associate professor Adaora Adimora. Peter Ndumbe of the Center for the Study and Control of Communicable Diseases, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon, was also a co-author.


University of North Carolina at Chapel Hill

210 Pittsboro St., Campus Box 6210

Chapel Hill, NC 27514

United States

unc.edu

Awakening Desire: Understanding Female Sexual Dysfunction

Many women experience problems in the bedroom at one time or another. Female sexual dysfunction is not uncommon and although some women and healthcare providers have difficulty discussing it, it has been recognized by the medical community for decades. In fact, for the last twenty years, it has been listed in the Diagnostic and Statistical Manual of Mental Disorders, a manual published by the American Psychiatric Association, used to classify and diagnose psychological disorders.


Female sexual dysfunction (FSD) can develop at any age, but many women report sexual problems at times of hormonal fluctuation; for example: post-pregnancy or during menopause. FSD encompasses several conditions that can have an effect on a woman's health and cause concern and suffering. These symptoms include:


- The desire to have sex is low or absent.

- An inability to maintain arousal during sexual activity, or become aroused despite a desire to have sex.

- An inability to experience an orgasm.

- Pain during sexual contact.


Hypoactive sexual desire disorder (HSDD) affects roughly 1 in 10 women and is the most common sexual dysfunction among women of all ages. It is sometimes difficult to diagnose because a woman's sex drive varies tremendously from person to person. And the factors causing a lowered sex drive can range from psychological to biological. But some women underestimate what an important role sexual health plays in their overall health and well-being. And if the lack of desire becomes distressing in any way or interferes with her overall quality of life, she may have HSDD.


Many women suffer in silence and some even feel that a decline in sexual desire is a normal part of aging. According to Sheryl A. Kingsberg, PhD, a clinical psychologist and Professor in the Department of Reproductive Biology at Case Western Reserve University School of Medicine in Cleveland, Ohio: "Women should not be expected to accept a distressing loss of sexual desire any more than they should be expected to simply accept arthritis, acid reflux, or any other condition often associated with aging."


Unfortunately, HSDD in women is not as well recognized as erectile dysfunction (ED) in men. There are many medications available for the treatment of ED, but currently, there are no US FDA approved medications for women with HSDD. "The problem is further compounded by a lack of attention and interest in women's sexual satisfaction in many cultures," says Kingsberg. And as a result, "some women may feel that it is not appropriate to seek help for a sexual problem."


There are options available. An important step in getting help for FSD is realizing that there is a problem. Too many women ignore their symptoms or are unable to recognize that they have a treatable issue. Kingsberg suggests that: "Women should speak to their partners about the problem and (they may consider) seeing a professional for guidance; this professional may be a counselor, a sex therapist, a physician or nurse practitioner, or some other trusted person."


Psychotherapy or sex therapy can be very effective in uncovering the different components that may contribute to the problem. There are a few medical treatments which include hormonal therapies that may help some women. "A number of other very exciting new approaches to the treatment of low sexual desire in women are under development," say Kingsberg, "and may be available soon."


Source

Society for Women's Health Research (SWHR)

Actions Taken On Abortion-Related Legislation In Arizona, Mississippi, New Hampshire, Wyoming

The following highlights recent news of state actions on abortion-related legislation.

Arizona: The House last week voted 34-21 to approve a bill (HB 2641) that outlines methods judges can use when minors seeking abortions request a judicial bypass for the state's parental consent requirement, the AP/KOVA reports. Under the bill, judges could consider factors such as the girl's age, experiences outside the home, travel, personal finances and experience in making "other significant decisions." Judges also could consider what actions the girl took to examine her options, as well as her consideration of the potential consequences of each option. The bill now goes to the Senate for consideration. A 2000 state law requires minors seeking abortions to obtain parental consent but allows for judicial bypasses. Gov. Janet Napolitano in April 2006 vetoed a similar bill (AP/KOVA, 3/9).

Mississippi: The Senate on Thursday gave final approval to a measure (SB 2391) that would ban abortions except in cases of rape or to save the life of a pregnant woman if Roe v. Wade -- the 1973 U.S. Supreme Court case that effectively barred state abortion bans -- were overturned, the AP/WLOX-TV reports (AP/WLOX-TV, 3/8). The House last month voted 95-16 to pass the measure, which condensed three abortion-related bills that passed the Senate. The legislation also would require minors seeking abortion who do not have their parents' consent to obtain permission from a judge to undergo the procedure. In addition, doctors would be required to give women seeking abortions a chance to listen to the fetus' heartbeat and view a sonogram. If Roe were overturned, anyone who performed an abortion violating the ban would be sentenced to one to 10 years in prison (Kaiser Daily Women's Health Policy Report, 2/26). The bill was sent to Gov. Haley Barbour (R), who is "inclined to sign" the measure but wants to review it first, his spokesperson Pete Smith said. If Barbour signs the bill, the parental notification and sonogram provisions would take effect July 1 (AP/WLOX-TV, 3/8).

New Hampshire: The House last week voted 226-130 to pass a bill (HB 184) that would repeal a state law (HB 763) requiring physicians in the state to notify by certified letter a parent or guardian of a minor who is seeking an abortion at least 48 hours before performing the procedure, the Manchester Union Leader reports (Fahey, Manchester Union Leader, 3/11). The law also bars parents from forbidding the procedure, and the notification requirement could be bypassed by a judge if a doctor determines that the minor's life is in danger. Planned Parenthood of Northern New England; the American Civil Liberties Union; the Concord Feminist Health Center; the Feminist Health Center of Portsmouth, N.H.; and Manchester, N.H.-based ob-gyn Wayne Goldner in November 2003 filed a lawsuit challenging the constitutionality of the law. U.S. District Judge Joseph DiClerico and the 1st U.S. Circuit Court of Appeals subsequently struck down the entire law. New Hampshire Attorney General Kelly Ayotte (R) appealed the rulings to the U.S. Supreme Court, saying that the judicial bypass clause in the measure combined with other state laws that allow doctors to act in an emergency protect a woman's health. The Supreme Court in January 2006 unanimously ruled that the lower courts should not have invalidated the entire measure and ordered lower courts to review the legislative intent regarding exceptions to the law for medical emergencies. DiClerico on Feb. 1 said he will continue to block enforcement of the law while the Legislature considers a measure that would repeal it (Kaiser Daily Women's Health Policy Report, 2/12). According to the Union Leader, the House last week defeated two amendments that would have changed the parental notification law to address the Supreme Court's concerns (Fahey, Manchester Union Leader, 3/8). The repeal still must be approved by the Senate, and Rep. Edmond Gionet (R) last week asked for the bill to be reconsidered in the House. Gov. John Lynch (D) has said he would sign the repeal (Manchester Union Leader, 3/11). Opponents of the repeal say it is unconstitutional, denies parental rights and responsibilities, and endangers minors (Dornin, Golden Dome News/Fosters Daily Democrat, 3/8).














Wyoming: Gov. Dave Freudenthal (D) has vetoed a bill (SF 118) that would have allowed any person who knowingly kills a pregnant woman to be charged with two counts of homicide, the AP/Billings Gazette reports (Miller, AP/Billings Gazette, 3/9). The bill text said, "Whoever willfully kills any pregnant woman knowing that the woman is pregnant, and thereby causes the involuntary termination of the woman's pregnancy without a live birth, is guilty of homicide of an unborn child or fetus and shall be imprisoned in the penitentiary for any term not less than 20 years and not more than life" (Kaiser Daily Women's Health Policy Report, 3/7). The Senate voted 16-12 to pass the measure and the House voted 35-24 to approve it. The Legislature has adjourned for the year, and lawmakers would need to call a special session to vote on a veto override, according to the AP/Gazette. Freudenthal in his veto letter said there was an "internal inconsistency" in the bill that would have allowed two counts of homicide when the woman and fetus are killed, but no counts of homicide when the fetus is killed and the woman survives. "I am simply not willing, by signing this act, to involve Wyoming in that divisive debate through this indirect means unless there is some compelling need to do so," Freudenthal wrote, adding, "This act simply creates too many problems without any benefit to the state and its citizens that I can perceive." According to the AP/Gazette, the governor met with representatives from Right to Life of Wyoming and NARAL Pro-Choice Wyoming before issuing the veto (AP/Billings Gazette, 3/9).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Eight California Physicians Being Investigated For Allegedly Purchasing IUDs From Unlicensed Vendors

Eight Southern California physicians are being investigated for allegedly obtaining intrauterine devices from unlicensed Internet- or Mexico-based vendors, state health officials said, the Los Angeles Times reports (Lin, Los Angeles Times, 9/10). Physicians in the state are required to purchase IUDs from licensed U.S. distributors that are approved by FDA, according to the AP/San Jose Mercury News. State authorities have ordered the physicians to notify the roughly 850 women who had received IUDs from their practices since Jan. 1, 2005, about the situation (AP/San Jose Mercury News, 9/10). In addition, state health officials are advising women who have received IUDs to check with physicians to determine if the device should be removed, the Times reports. Mark Horton, a state health official, in a statement said, "The physicians under investigation have failed to provide proper evidence that shows they purchased federally approved IUDs from FDA-approved sources." He added that the IUDs' "safety and effectiveness are unknown." However, Susann Steinberg, another state health official, said that no health risk has been identified among the women who received the devices and that IUDs used abroad "seem to be effective and safe in the countries they are used." According to the Times, one of the physicians being investigated -- Hezekiah Moore of Long Beach -- has refused to notify his patients about the situation and said he will not implicate himself for possibly violating state and federal laws. State health officials will notify Moore's patients about the allegations and are seeking to suspend Moore from receiving Medi-Cal and Family PACT funding, the Times reports. The seven other physicians being investigated have not been identified, and the cases are being referred to FDA, the state Justice Department and the Medical Board of California (Los Angeles Times, 9/10).


"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . ?© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

New HHS Regulation Poses Threat To Women's Health

According to The American College of Obstetricians and Gynecologists (ACOG), a new regulation proposed by the Department of Health and Human Services (HHS) could limit women's access to appropriate, complete, and accurate reproductive health information and services and seriously jeopardize the doctor-patient relationship.


ACOG supports a reasonable balance between a physician's right to his or her moral or religious beliefs and a patient's right to needed health care, including reproductive health information and services. Current law, dating back 30 years, protects individuals who refuse to provide abortions and sterilizations because of objections based on religious or moral beliefs.


On August 26, 2008, HHS released a proposed regulation, with a stated intent of educating health providers about and enforcing these laws. This regulation extends the conscience protection well beyond physicians and others directly involved in patient care-the personal beliefs of pharmacists, schedulers, even volunteers and custodians could influence the information patients receive or stop patient care. And this regulation does not make any exceptions for cases in which a patient's need for emergency medical care might override an individual provider's objection.


Patients expect their doctors to give them full and honest answers to their health questions. However, this HHS regulation does not require health care professionals to disclose their personal objections to patients.


This proposal, which would apply to all institutions and physicians receiving federal funding for health services or research, is riddled with important unanswered questions. The following issues must be addressed, fully and to the satisfaction of the medical community, before this regulation proceeds any further:


- Would employers retain rights, guaranteed under Title VII of the Civil Rights Act, to set reasonable limits on their employees' exercise of religion in the workplace?


- What is an employer's recourse under this proposal if an employee is consistently unwilling to perform his or her job due to moral objections?


- How does this proposal guarantee that patients would know in advance any religious or moral boundaries a provider has that might limit their care options?


- How does the proposal reconcile the requirements of Title X Family Planning and Medicaid, which require providers to give their patients nondirective counseling?


- What would the effect of this proposal be on state laws that require employers who offer prescription drug coverage to also cover contraceptives; require emergency rooms to offer emergency contraception to rape victims; and require pharmacies to fill prescriptions for birth control and emergency contraception?


- How does the proposal guarantee that patients' emergency medical needs would be met?















Moreover, ACOG vehemently takes issue with HHS Secretary Leavitt's justification for this new regulation. Secretary Leavitt is wrong in citing that ACOG requires its ob-gyn members to perform abortions, and he is wrong in claiming that the American Board of Obstetrics and Gynecology (ABOG), the organization that oversees board certification, requires an ob-gyn to perform abortions in order to be certified.


First, ACOG recognizes that the issue of support of or opposition to abortion is a matter of profound moral conviction to its members and, therefore, respects the need and responsibility of its members to determine their individual positions based on personal values or beliefs.


As for the document in question, ACOG affirms that while an individual physician is under no obligation to perform a procedure that conflicts with his or her conscience, neither should an individual physician's conscientious objection create a barrier to a patient's access to reproductive health care. Likewise, institutions and organizations should, to the best of their abilities, ensure nondiscriminatory access to all professional services while minimizing the need for practitioners to act in opposition to their deeply held beliefs.


Second, ABOG has repeatedly stated that refusal to perform or refer for abortion is not a consideration for initial certification or maintenance of physician board certification. Not only is it grossly untrue, but it is disingenuous of Secretary Leavitt to continue making the assertion that physicians risk losing board certification. Furthermore, ABOG has challenged Secretary Leavitt to provide any evidence of discrimination that he alluded to in a news release last month. To date, no proof to support his accusations has been provided.



The American College of Obstetricians and Gynecologists is the national medical organization representing over 52,000 members who provide health care for women.

American College of Obstetricians and Gynecologists

House Approves Bill That Would Allow Contraceptive Donations To International Groups Barred From Funding

The House on Thursday voted 241-178 to approve a fiscal year 2008 foreign aid spending bill that would allow the federal government to give contraceptives but not money to international groups barred from receiving U.S. aid because of their abortion policies, the Washington Post reports (Williamson, Washington Post, 6/22).

The so-called "Mexico City" policy bars U.S. funding from going to international groups that support abortion, even with their own money, through direct services, counseling or lobbying activities. The policy was originally implemented by former President Reagan at a population conference in Mexico City in 1984, removed by former President Clinton and reinstated by President Bush during the first days of his presidency. Bush in September 2003 issued an executive order that prevents the State Department from giving family planning grants to international groups that provide abortion-related counseling.

Rep. Nita Lowey (D-N.Y.), chair of the House Appropriations Subcommittee on State, Foreign Operations and Related Programs, recently said the legislation leaves the Mexico City policy intact, but Republicans disagreed and cited a threat by Bush to veto legislation that would change current abortion-related policies and laws. Bush last month in a letter to House Speaker Nancy Pelosi (D-Calif.) and Senate Majority Leader Harry Reid (D-Nev.) said he will veto any legislation that would weaken federal policies or laws on abortion, including measures that would "allow taxpayer dollars to be used for the destruction of human life" (Kaiser Daily Women's Health Policy Report, 6/13).

According to the AP/Guardian, 207 Democrats and 16 Republicans voted in favor of the bill. Twenty-four Democrats and 177 Republicans voted against the measure, and more than a dozen members did not vote, the AP/Guardian reports (Flaherty, AP/Guardian, 6/22). The House voted 218-205 against an amendment, introduced by Reps. Christopher Smith (R-N.J.) and Bart Stupak (D-Mich.), that would have reinforced the existing policy, CongressDaily reports (Cohn, CongressDaily, 6/22). The Senate tentatively plans to vote on its version of the foreign aid spending measure on Thursday, the Los Angeles Times reports (Havemann, Los Angeles Times, 6/22).

Comments
Lowey said the provision provides easier access to contraception and the bill would help reduce abortions, unintended pregnancies and the spread of HIV. "This amendment would advance the Bush administration's stated goal of the Mexico City policy to 'make abortion more rare,' and protect women and children," she said, adding, "It is simply not enough to say you support family planning, so long as the current restrictions remain in law" (Lengell, Washington Times, 6/22). Rep. Jim Langevin (D-R.I.), who opposes abortion rights, said he supports the bill because it would "allow ... critical lifesaving assistance to reach those who desperately need it" (CongressDaily, 6/22).














Rep. Joe Pitts (R-Pa.) said the "Mexico City policy exists to draw a bright line between U.S. family planning policy and abortion." He added, "However, it appears that there are some out there who wish to blur this line, (which) is what leads to coercive abortions and forced sterilizations" (AP/Guardian, 6/22). House Minority Leader John Boehner (R-Ohio) said, "This bill represents an unconscionable policy reversal that dramatically weakens current pro-life policies" (Washington Post, 6/22).


NPR's "Morning Edition" on Friday reported on the House bill, as well as a Senate appropriations bill that contains provisions related to embryonic stem cell research. The segment includes comments from Rep. Tim Ryan (D-Ohio), Pitts, Sen. Robert Byrd (D-W.Va.) and Sen. Tom Harkin (D-Iowa) (Rovner, "Morning Edition," NPR, 6/22). Audio of the segment is available online.

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

High Rates Of Caesarean Delivery May Harm Mothers And Newborns

High rates of caesarean delivery in Latin America can be associated with a greater risk of maternal and newborn illness and death, report the authors of a paper published online by The Lancet (Tuesday May 23, 2006).


Caesarean delivery rates are increasing worldwide. During 2005, Jose Villar (World Health Organization) and colleagues assessed the association between rates of caesarean delivery and maternal and newborn outcomes in hospitals in Latin America. 120 public, private, and social security hospitals from 24 geographic regions in eight countries in Latin America were randomly selected for inclusion in the study (91% of the population were served by these hospitals). The investigators analysed over 97 000 deliveries. They found that hospitals with high rates of caesarean delivery had higher rates of severe maternal illness, death, and antibiotic treatment post pregnancy, even after they adjusted for risk factors such as the characteristics of the women, referrals, and the type of hospital. They also found that rates of preterm delivery and newborn deaths rose with the increasing rates of caesarean delivery of between 10% and 20%.


Dr Villar states: "In conclusion, high rates of caesarean delivery do not necessarily indicate good quality care or services. Indeed institutions that deliver a lot of babies by caesarean should initiate a detailed and rigorous assessment of the factors related to their obstetric care and the perinatal outcomes achieved vis-?-vis the case mix of the population they serve; at present their services might cause iatrogenic harm."


Iatrogenic means doctor-related


Joe Santangelo

j.santangeloelsevier

Lancet

thelancet

New Model Predicts Breast Cancer Risk In African-American Women

Researchers have developed a new risk prediction model that more accurately estimates the breast cancer risk of African American women, according to a study published online November 27 in the Journal of the National Cancer Institute.



The Breast Cancer Risk Assessment Tool, also known as the Gail model, is widely used for estimating breast cancer risk and for determining which women are eligible for breast cancer prevention trials. However, much of the model was based on breast cancer data from white women, so it is unclear how well the model applies to African American women or those from other racial groups. The Women's Contraceptive and Reproductive Experiences (CARE) study was conducted to obtain data on African American women with and without breast cancer.



Mitchell Gail, M.D., Ph.D., of the National Cancer Institute in Bethesda, Md., and colleagues used data from the CARE study and the Surveillance, Epidemiology, and End Results (SEER) program to build a new model for estimating breast cancer risk in African American women. They then used data from two trials - the Women's Health Initiative and the Study of Tamoxifen and Raloxifene (STAR) - to test the model.



The new CARE model accurately predicted the number of cancers observed in African American women in the Women's Health Initiative overall and in most subgroups. CARE model risk predictions usually were higher than those from the Gail model in women aged 45 and older. The researchers estimated that 30 percent of African American women would have a 5-year breast cancer risk of at least 1.66 percent, which would have qualified them for participation in the STAR trial, compared with the estimate of 14.5 percent using the Gail model.



The CARE model is not recommended for women with a previous history of breast cancer, and it may underestimate breast cancer risks in certain other women, such as those who carry a BRCA mutation.



"Despite these limitations, the CARE model appears to offer more valid and usually larger estimates of invasive breast cancer risk for African American women than the currently available [Gail model]. Although we are aware of the need for additional validation studies, we recommend the CARE model for counseling African American women and for determining the eligibility of African American women for breast cancer prevention trials," the authors write.







Citation: Gail MH, Costantino JP, Pee D, Bondy M, Newman L, Selvan M, Anderson GL, et al. Projecting Individualized Absolute Invasive Breast Cancer Risk in African American Women. J Natl Cancer Inst 2007; 99:1782-1792



The Journal of the National Cancer Institute is published by Oxford University Press and is not affiliated with the National Cancer Institute. Visit the Journal online at jnci.oxfordjournals/.



Source:

Liz Savage

Journal of the National Cancer Institute

Lancet Editorial Links Access To Birth Control, Benefits To The Environment

Providing no-cost contraception to women in developing countries could help slow population growth -- and thus climate change -- according to an editorial by Leo Bryant of Marie Stopes International published Friday in the journal Lancet, the AP/Google News reports. According to the editorial, more than 200 million women worldwide want access to modern contraceptives but do not have it, resulting in 76 million unintended pregnancies annually. Family planning is much less costly than typical methods used to fight climate change, the editorial states. It cites a British report that found each $7 spent on basic family planning would translate into a one-ton reduction in carbon dioxide emissions (AP/Google News, 9/18).

Bryant -- the lead researcher on the World Health Organization study of climate change and population growth -- said that there is a stigma attached to contraception in both developing and developed countries that is hindering progress. According to the WHO study, nearly all of the world's 40 poorest countries have linked rapid population growth to an environmental impact, but only six have proposed steps to address the issue.

The world's population is on pace to increase by one-third -- to more than nine billion people -- by 2050, with 95% of that growth in developing countries, Reuters/Fox News reports. Bryant notes in the editorial that most countries with good access to birth control experience a dramatic decrease in average family size within a generation.

Bryant said, "We are certainly not advocating that governments should start telling people how many children they can have." He added, "The ability to choose your family size ... is a fundamental human right. But lack of access to family planning means million of people in developing countries don't have that right" (Kelland, Reuters/Fox News, 9/18).


Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.


© 2009 The Advisory Board Company. All rights reserved.

Depression In Women With Migraine Linked To Childhood Abuse

Childhood abuse is more common in women with migraine who suffer depression than in women with migraine alone, according to a study published in the September 4, 2007, issue of Neurology, the medical journal of the American Academy of Neurology.


"This study confirms adverse experiences, particularly childhood abuse, predispose women to health problems later in life, possibly by altering neurobiological systems," said study author Gretchen Tietjen, MD, with the University of Toledo Health Science Campus and a member of the American Academy of Neurology.


Researchers surveyed 949 women with migraine about their history of abuse, depression and headache characteristics. Forty percent of the women had chronic headache, more than 15 headaches a month, and 72 percent reported very severe headache-related disability. Physical or sexual abuse was reported in 38 percent of the women and 12 percent reported both physical and sexual abuse in the past. These results for abuse are similar to what's been reported in the general population.


The association between migraine and depression is well established, but the mechanism is uncertain. The study found women with migraine who had major depression were twice as likely as those with migraine alone to report being sexually abused as a child. If the abuse continued past age 12, the women with migraine were five times more likely to report depression.


"The finding that a variety of somatic symptoms were also more common in people with migraine who had a history of abuse suggests that childhood maltreatment may lead to a spectrum of disorders, which have been linked to serotonin dysfunction," said Tietjen.


"Our findings contribute to the mounting data that show abuse in childhood has a powerful effect on adult health disorders and the effect intensifies when abuse lasts a long time or continues into adulthood," said Tietjen. "The findings also support research suggesting that sexual abuse may have more impact on health than physical abuse and that childhood sexual abuse victims, in particular, are more likely to be adversely affected."


The study also found women with depression and migraine were twice as likely to report multiple types of abuse as a child compared to those without depression, including physical abuse, fear for life, and being in a home with an adult who abused alcohol or drugs.


"Despite the high prevalence of abuse and the increased health costs associated with it, few physicians routinely ask migraine patients about abuse history," said Tietjen. "By questioning women about their abuse history we'll be able to better identify those women with migraine at increased risk for depression."


The study was supported by a grant from the American Headache Society.


The American Academy of Neurology, an association of more than 20,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer's disease, epilepsy, Parkinson's disease, and multiple sclerosis.


For more information about the American Academy of Neurology, visit aan.


American Academy of Neurology (AAN)

1080 Montreal Ave.

St. Paul, MN 55116

United States

neurology

Computer Interpretation Of Mammograms No Better Than Experienced Eye

A US study suggests that computer-aided detection (CAD) does not help radiologists interpret mammograms more accurately and produces worse results than
experienced radiologists using their eyes alone.


The study is published in the New England Journal of Medicine (NEJM).


Approved by the Food and Drug Administration (FDA) in 1998, CAD scans mammogram X-rays and highlights suspicious areas for the radiologist to look at in
more detail. CAD is used as a supplementary tool to support the radiologist. On average CAD highlights about 4 areas on each mammogram.


However, Joshua Fenton, assistant professor of family and community medicine with the University of California, Davis Health System in Sacramento, and
colleagues found that using CAD was more likely to lead to false positives, where benign growths are marked as potential cancer tumours.


The result is that women are called back for biopsies which are not necessary and this results in unnecessary cost to the hospital and also anxiety and
stress to patients.


The researchers examined the relationship between CAD and mammography screening performance between 1998 and 2002 at 43 screening centres in 3
states.


The data they used came from 429,345 mammograms and 222,135 women, including 2,351 who were diagnosed with breast cancer within 12 months of being
screened.


They looked at three aspects of mammography performance with and without CAD:


-- specificity (how well a negative result is identified),

-- sensitivity (how well a positive result is identified), and

-- positive predictive value (the proportion of patients with positive test results who are correctly diagnosed).


And they also measured the overall accuracy and individual rates of biopsy and breast cancer detection.


The findings showed that:


-- 7 of the 43 (16 per cent) of the centres started using CAD during the period of the study.

-- Diagnostic specificity decreased from 90.2 per cent before, to 87.2 after, CAD was brought in.

-- Positive predictive value decreased from 4.1 to 3.2 per cent before and after CAD.

-- Rate of biopsy increased by 19.7 per cent before and after CAD.

-- Sensitivity increased from 80.4 per cent before CAD to 84.0 per cent after CAD but this was not significant.

-- Cancer-detection rate changed from 4.15 to 4.20 cases fer 1,000 screenings but this was not significant.

-- Analyses of all 43 centres showed CAD linked significantly with lower overall accuracy compared with no CAD.


The researchers concluded that the use of CAD is:


"associated with reduced accuracy of interpretation of screening mammograms. The increased rate of biopsy with the use of computer-aided detection is not
clearly associated with improved detection of invasive breast cancer".















In an accompanying editorial a radiology professor at Beth Israel Deaconess Medical Center in Boston, Ferris Hall, said this does not mean radiologists are
about to stop using CAD, but it does make a dent in the technology's reputation.


Hall called for larger studies to look in more detail at how the technology is used and the best ways to use it to support radiologists.


He said that while CAD on average finds between two and four suspicious areas, only one in 2,000 is cancerous.


While the technology is there to help radiologists find suspicious marks on the mammogram, since it was approved by the FDA in 1998, "its effect on the on
the accuracy of interpretation is unclear".


Hall appears to favour moving toward a combination of methods including genetic risk profiling and MRI (magnetic resonance imaging).


Mammography has its place, but he described it as a "poor, two-dimensional projectional method being used to diagnose small, three-dimensional cancers".


Also, MRI does not carry the risk of radiation exposure and it is more sensitive, although has lower specificity compared to mammography.


He alludes to the reluctance to adopt mammography when it first arrived on the scene, and suggests MRI is experiencing the same lack of acceptance: "the major problems with MRI of the breast and related magnetic resonance spectroscopy are cost and interpretive expertise", he writes.


A mammogram is a low dose X-ray of the breast. It is used to find potential tumours and cysts before they get big enough to be felt by hand and in many
countries it is a routine screening method for early detection of breast cancer in older women.


In the US, breast cancer is the second most common cancer in women, skin cancer is the most common.


According to American Cancer Society estimates, about 178,000 women will discover they have breast cancer this year, and over 40,000 will die from
it.


The Society has recently announced that MRI (magnetic resonance imaging) should be used to screen women with a high risk of breast cancer.



"Influence of Computer-Aided Detection on Performance of Screening Mammography."

Fenton, Joshua J., Taplin, Stephen H., Carney, Patricia A., Abraham, Linn, Sickles, Edward A., D'Orsi, Carl, Berns, Eric A., Cutter, Gary, Hendrick, R.
Edward, Barlow, William E., Elmore, Joann G.

N Engl J Med 2007 356: 1399-1409.

Volume 356:1399-1409, April 5, 2007, Number 14.


Click here for Abstract.


Click here
for more information about Mammograms and Other Breast Imaging Procedures (American Cancer Society).


: Catharine Paddock

Writer: blog

Early Menstruation Linked To Increased Risk Of Depressive Symptoms

Girls who begin menstruating at an early age are at greater risk of depressive symptoms in adolescence, according to new research published in the January issue of the British Journal of Psychiatry.



Researchers from the University of Bristol and the University of Cambridge examined the link between timing of first period and depressive symptoms in a sample of 2,184 girls taking part in a long-term study known as the Avon Longitudinal Study of Parents and Children.



The researchers used a structural equation model to examine the association between onset of menstruation and depressive symptoms at ages 10.5, 13 and 14 years.



The mean age at which the girls in the study group started menstruating was 12 years and 6 months. They found that girls who started their periods early (before the age of 11.5 years) had the highest levels of depressive symptoms at ages 13 and 14. Girls who started their periods later (after the age of 13.5 years) had the lowest levels of depressive symptoms.



Lead researcher Dr Carol Joinson said: "Our study found that girls who mature early are more vulnerable to developing depressive symptoms by the time they reach their mid-teens. This suggests that later maturation may be protective against psychological distress.



"The transition into puberty is a critical developmental period, associated with many biological, cognitive and social changes. These can include increased conflict with parents, the development of romantic relationships, changes in body image and fluctuating hormone levels. These changes may have a more negative impact on girls who mature at an early age than those who mature later. Early maturing girls may feel isolated, and faced with demands which they are not emotionally prepared for."



Dr Joinson concluded: "If girls who reach puberty early are at greater risk of psychological problems in adolescence, it may be possible to help them with school- and family-based programmes aimed at early intervention and prevention."



However, it is still unclear from this study whether early menstruation is associated with persistent adverse consequences for emotional development beyond mid-adolescence. The researchers point out it is possible that girls who mature later may eventually experience similar levels of psychological distress to those who mature earlier, after sufficient time has unfolded.



The research was funded by the Economic and Social Research Council.



References:


Joinson C, Heron J, Lewis G, Croudace T and Araya R. Timing of menarche and depressive symptoms in adolescent girls from a UK cohort. British Journal of Psychiatry 2011; 198:17-23


Source:

Royal College of Psychiatrists

Newsweek Examines Issue Of Gender Rating In Health Reform Debate

Newsweek's Sarah Kliff recently examined the health insurance industry practice known as gender rating and the issue's role in the health reform debate. Kliff reports that in the current individual insurance market, gender is among the many factors that health insurers "routinely use to predict a consumer's costs and thus the price of their premiums." While the insurance industry says the practice is "smart business," others call it "outright discrimination" that leaves many women unable to afford coverage, according to Kliff.

Federal law bans employers with more than 15 workers from charging different health insurance premiums based on gender and other factors, and 12 states either prohibit or limit gender rating. Advocates and policymakers opposed to the practice have called it a form of "gender discrimination," Kliff says. The issue "came to a head" in 2008 when the National Women's Law Center released a report showing widespread variation in insurers' gender rating practices, with premiums varying significantly between insurance companies and states. For example, the report found that a 25-year-old woman could be charged between 6% and 45% more than a man of the same age. The "huge variations in premiums charged to women and men for identical health plans highlight the arbitrariness of gender rating," the report said.

Insurance companies defend the practice, arguing that women should pay more in premiums because they cost more to insure. Ethan Slavin, a spokesperson for Aetna, said that "using gender as one factor in the rating process helps ensure that premiums fairly reflect each individual's expected costs and how they currently contribute to the overall pool of available insurance coverage." Research has found that, in addition to added maternity costs, women are more likely to visit their doctors and incur higher costs than men. This changes around age 50, when men usually require more health care and women are charged lower premiums, according to Kliff.

Supporters of gender rating also argue that if the practice were prohibited, "adverse selection" could occur, with men dropping out of the system because they feel that they are paying too much relative to the benefits they receive, Kliff says. For example, insurance rates for young women in 1994 in Kentucky were 150% of rates for young men, which prompted the state Legislature to pass a law limiting the ability of insurance companies to charge different premiums based on gender and other factors. Over the next decade, low-risk individuals, such as men who felt they were overcharged, opted out of the market. By 1998, about 40 insurance companies had left the market. Kentucky largely repealed the law in 1998, and insurance companies returned to the state, Kliff reports.














According to Kliff, Kentucky's case shows how "small changes in regulation can ripple through a market to have a serious, and not necessarily favorable, impact," although "by no means is Kentucky the rule." For example, in 1993 Montana successfully outlawed gender rating "and never looked back," she says. "And even if some adverse selection does occur, advocates of gender-neutral policies say that's OK -- there are larger, philosophical issues at stake," Kliff reports. The NWLC report said that advocates in states with successful laws restricting gender rating have found that "society considers gender discrimination to be just as repugnant as racial discrimination" and that insurers should eliminate the practice as they did for race discrimination in the 1950s and 1960s.

In the congressional health reform debate, the "tide seems to be turning in favor of eliminating gender ratings," Kliff writes. In a statement released in May, America's Health Insurance Plans said it supports "discontinuing rating based on a person's health status or gender" so long as there is a "personal coverage requirement to get everyone into the system." Kliff says the "personal coverage requirement" part of the statement "is key to what AHIP is saying," because "if everyone had to sign up for health care, adverse selection becomes a moot point: there isn't any selection at all." However, individual mandates are becoming a "contested point" in the debate, and observers can "expect to see insurance companies rethinking their support for scrapping gender ratings" if the mandates are not included in the final legislation, Kliff says (Kliff, Newsweek, 10/19).


Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.


© 2009 The Advisory Board Company. All rights reserved.

Royal Colleges Issue Recommendations For The Safe Organisation Of Care During Labour And Birth

New recommendations on standards for the safe organisation of care during childbirth have been issued today by the Royal Colleges of Anaesthetists (RCOA), Midwives (RCM), Obstetricians and Gynaecologists (RCOG), and Paediatrics and Child Health (RCPCH).


The joint document, Safer Childbirth: Minimum Standards for the Organisation and Delivery of Care in Labour, provides clear and concise information about the roles and essential minimum staffing levels required to support and deliver safe care to women in labour and their babies.


Underpinning the guideline is the need for good working relationships between a multi-disciplinary maternity team of midwives, obstetricians, anaesthetists, paediatricians, as well as support and managerial staff. Also of paramount importance is the expansion in numbers of midwives and obstetricians to enable appropriate and safe care to be provided. The document addresses the requirements for successful workforce planning and provides health facilities with a blueprint from which to implement their services.


The report recognises the complimentary and respective roles of the whole maternity team caring for women in normal or more complicated labour. It also recommends the need for access to senior staff to provide advice and support in all labour environments.


Baseline standards are recommended in the following ten categories:


1. Organisation and documentation

2. Multidisciplinary working

3. Communication

4. Staffing levels

5. Leadership

6. Core responsibilities

7. Emergencies and transfers

8. Training and education

9. Environment and facilities

10. Outcomes


Key recommendations include:


- Women in established labour must receive individual one-to-one care from a midwife .


- Outside the recommended minimum 40 hours of consultant obstetrician presence on the labour ward, the consultant will conduct a physical ward round as appropriate at least twice a day during Saturdays, Sundays and bank holidays, with a physical round every evening, reviewing midwifery-led cases on referral


- All women requiring conduction or general anaesthesia are seen and assessed by an anaesthetist before an elective procedure


- A healthcare professional (midwife, neonatal nurse, advanced neonatal nurse practitioner, paediatrician) trained and regularly assessed as competent in neonatal basic life support must be immediately available for all births, in any setting


Dr Judith Hulf, President of the RCoA, said "Safety is core business in anaesthesia and nowhere is it more important than in maternity services. The contents of this document highlight the key areas that must be addressed. The importance of effective multidisciplinary team-working for all mothers, whether healthy or sick, cannot be overemphasized."


Maggie Elliott, President of the RCM, said: "Women and their babies sit at the heart of these recommendations, which address many of the issues affecting the delivery of safe, quality care wherever women give birth. Midwives will welcome the focus on direct communication, the need for better staffing levels and a commitment to respectful and equitable relationships between all members of the maternity care team. This can only result in a better birth experience for women, their babies and families."















Professor Sabaratnam Arulkumaran, President of the RCOG, said "We hope that the clear guidelines presented in Safer Childbirth will be adopted by those caring for women in labour, in all settings, to ensure quality and continuity of care in UK maternity services. This project has been an important collaboration between the Royal Colleges and we hope that our focus on the multi-disciplinary team approach leads to safer childbirth in our hospitals."


Dr Jane Hawdon, RCPCH, said "The Royal College of Paediatrics and Child Health strongly supports the multidisciplinary approach to the planning and conduct of childbirth. Whilst acknowledging that improving maternity care should reduce the need for paediatric intervention, on occasions, skilled assessment and support are needed for the baby and this must be available at every location where childbirth occurs. For this reason we are delighted that the assessment and care of the baby is firmly embedded in the midwife's role. In addition, all hospitals must meet the British Association of Perinatal Medicine (BAPM) standards for neonatal care."


Reference


Safer Childbirth: Minimum Standards for the Organisation and Delivery of Care in Labour, Royal College of Anaesthetists, Royal College of Midwives, Royal College of Obstetricians and Gynaecologists, and Royal College of Paediatrics and Child Health; London; 2007


The full report can be downloaded here.

rcog

Mo. Appeals Court Rules That State Law Does Not Allow For Prosecution Of Pregnant Women For Causing Indirect Harm To Fetuses

In a recent case, the Missouri Court of Appeals in Kansas City ruled that a state law allowing criminal and civil action against a person who harms a pregnant woman and her fetus does not permit the prosecution of a pregnant woman for causing indirect harm to a fetus, the St. Louis Post-Dispatch reports.

The case involves Janet Wade, a Buchanan County woman who, along with her infant, tested positive for marijuana and methamphetamine use. The state law says that the life of a human being begins at conception and that fetuses have "protectable interests in life, health and well-being." According to the Post-Dispatch, the law, which was enacted in 1986, has been used successfully in murder and manslaughter cases, as well as in wrongful death lawsuits against people who have caused a fetus' termination.

A state circuit court judge dismissed the case against Wade because charges filed in the case were based on a section of the law that states: "Nothing in this section shall be interpreted as creating a cause of action against a woman for indirectly harming her unborn child by failing to properly care for herself or by failing to follow any particular program of prenatal care." The decision was upheld by appellate Judge Lisa White Hardwick.

St. Charles County Prosecutor Jack Banas said the appellate court's ruling could lead to challenges in other similar cases still pending. Buchanan County Prosecutor Dwight Scroggins on Wednesday said that he did not intend to ask the state Supreme Court to review the case. However, the state Legislature might be able to change the statute to prevent women from harming their fetuses with drugs and alcohol, Scroggins said (Anthony, St. Louis Post-Dispatch, 9/20).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

More Than One-Third Of Canadian Women Believe HPV Vaccines Prevent Ovarian Cancer, Survey Finds

More than one-third of Canadian women believe that human papillomavirus vaccines prevent ovarian cancer, and about 25% of women believe routine Pap tests detect ovarian cancer, a survey commissioned by Ovarian Cancer Canada found, Toronto's Globe and Mail reports. HPV vaccines can prevent infection of some human papillomavirus strains that can lead to cervical cancer, and Pap tests are conducted to detect early signs of cervical cancer, according to the Globe and Mail. The survey indicated confusion among women about gynecological cancers, Elizabeth Ross, CEO of Ovarian Cancer Canada, said (Picard, Globe and Mail, 9/4).

The American Cancer Society, Gynecologic Cancer Foundation and the Society of Gynecologic Oncologists in June announced recommendations for identifying symptoms that could signal the early stages of ovarian cancer. Experts from the groups called on women who experience the symptoms -- which include bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, and a frequent or urgent need to urinate -- every day for two to three weeks to see a gynecologist.

According to the specialists, women who have the symptoms should visit a gynecologist for a pelvic and rectal exam. If the exams suggest a possibility of ovarian cancer, the next step would be a transvaginal ultrasound and a blood test to detect CA125, a substance that is often elevated in women who have ovarian cancer (Kaiser Daily Women's Health Policy Report, 6/14). According to the Globe and Mail, 20% of women in the Canadian survey believed the CA125 test is used to screen for ovarian cancer, but it actually is used to mark ovarian cancer tumors.

"It is critical that young women know that the HPV vaccine and Pap tests for cervical cancers are not catchalls for diseases below the waist," Barbara Vanderhyden, the Corinne Boyer chair in ovarian cancer research at the University of Ottawa, said. Vanderhyden added that she is concerned many girls and young women will believe gynecological exams are not necessary if they have received an HPV vaccine. Ross said that the best way for women to detect ovarian cancer is to be aware of the symptoms.

An estimated 2,400 Canadian women will be diagnosed with ovarian cancer this year, and 1,700 will die of the disease, the Globe and Mail reports (Globe and Mail, 9/4).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Female Genital Mutilation Harmful For Mothers And Babies

Pregnant women with female genital mutilation (FGM) have a higher risk of losing their baby before or soon after birth than those without, according to a paper in this week's issue of The Lancet. The researchers also found that women with FGM had more birth-related problems.


FGM consists of all procedures that involve partial or total removal of the external female genitalia or other injury to the female genital organs for cultural or other non-therapeutic reasons. It is common in several countries, predominantly in Africa, and more than 100 million women and girls are estimated to have had FGM worldwide. Whether the outcomes for pregnant women with FGM differ from those without had been unclear until now; previous studies had been small and therefore unreliable.


In the latest study the World Health Organization (WHO) study group on female genital mutilation and obstetric outcome analysed data from 28, 373 women giving birth to a single baby between November 2001 to March 2003 at 28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal, and Sudan. The investigators examined the women for the presence of, and severity of, FGM prior to giving birth. After birth the women were followed-up until they were discharged from hospital. The team found that women with FGM were more likely to lose their baby during the perinatal period (just before and just after birth) than women who had not had FGM. The researchers found that FGM caused one to two extra perinatal deaths per 100 deliveries, in relation to a background risk of 4-6 perinatal deaths per 100 deliveries. Women with FGM were also more likely to have deliveries complicated by caesarean section, haemorrhage, surgical intervention to enlarge the vagina and assist birth, and extended hospital stays. The excess risk remained even after the researchers took into account other confounding factors, such as maternal age, maternal education, socioeconomic status, and antenatal care visits. The risks were also greater with more extensive FGM, report the authors.


The authors state: "This is a collaborative study conducted in Africa, with African researchers, and provides evidence of great importance to those communities where FGM is practiced. It shows clearly its harmful effects on reproductive outcome, both for women and their infants." (Quote by e-mail; does not appear in published paper)


Joe Santangelo

j.santangeloelsevier

Lancet

thelancet

Electronic Medical Records Could Help Predict Domestic Abuse

Research published on bmj today reports that doctors could forecast a patient's risk of receiving a domestic abuse diagnosis years in advance by using electronic medical records as an early warning system.


Dr Ben Reis from the Children's Hospital Boston Informatics Program and Harvard Medical School is the lead author. Researchers investigated whether the amount of historical electronic data could be used to identify high risk patients.


Reis explains: "Doctors typically do not have the time to thoroughly review a patient's historical records during the brief clinical encounter. As a result, certain conditions that could otherwise be detected are often missed. One such condition is domestic abuse, which may go unrecognised for years as it is masked by acute complaints that form the basis of clinical encounters."


In the United States, domestic abuse is the most frequent cause of nonfatal injury to women. Every year it accounts for more than half the murders of women. It affects both men and women and can result in serious injury and death. As a result, the authors state: "it is critical that at-risk patients be identified as early as possible."


There is proof that screening is a valuable tool in detecting domestic abuse. But the authors judge that doctors "may not be taking full advantage of the growing amounts of longitudinal data stored in electronic health information systems."


An analysis was completed using medical records from over 500,000 non-identifiable patients over 18 years of age. For these individuals, there was at least four years of data on admissions to hospital and visits to emergency departments. There were over 16 million diagnoses, from which some were identified as cases of abuse according to established record-keeping codes.


A scoring system was developed by the researchers. It predicted which patients were likely to receive a domestic abuse diagnosis. The system was effective in predicting future diagnoses of abuse an average of 10 to 30 months in advance.


Particular risk factors were strongly linked with a future diagnosis of abuse. The risk was highest after being seen in hospital or the emergency department for these events:

For women:

??? injuries

??? alcoholism

??? poisoning

For men:

??? mental health conditions such as depression and psychosis


In addition, researchers developed a prototype risk-visualization environment. It provides clinicians with instant overviews of longitudinal medical histories and related risk profiles at the point of care. The authors explain: "In conjunction with alerts for high-risk patients, this could enable clinicians to rapidly review and act on all available historical information by identifying important risk factors and long-term trends."


Reis claims that these risk profiles could help doctors diagnose domestic abuse much earlier, perhaps many years in advance. He underlines that: "With increasing amounts of data becoming available, this work has the potential to bring closer the vision of predictive medicine, where vast quantities of information are used to predict individuals' future medical risks in order to improve medical care and diagnosis."


"Longitudinal histories as predictors of future diagnoses of domestic abuse: modelling study"

Ben Y Reis, assistant professor, Isaac S Kohane, professor, Kenneth D Mandl, associate professor

BMJ 2009; 339:b3677

doi:10.1136/bmj.b3677

bmj


Stephanie Brunner (B.A.)